兩岸民眾健康素養與健康信念對自費健檢的使用與使用意願影響之探討—以大臺北地區及深圳為例

Abstract

背景：當今,給民眾健康造成威脅的主要病因已由過去的傳染性疾病，轉變為與生活型態關係密切的慢性疾病及身體機能退化性病症為主。不論是在慢性疾病或是在傳染性疾病的防治上，最常被舉出的疾病預防觀念為三段式的疾病預防。其目的就是希望在疾病發生之前提早發現，及早治療，而健康檢查是提早發現疾病的最佳辦法。台灣過去已有開辦成人預防保健服務，但由於內容比較簡易，且有年齡上的限制，無法完全滿足民眾對健康的需求，許多民眾仍會考量使用自費的健康檢查服務。近年來，自費健康檢查產業的崛起不只是台灣現象。隨著中國大陸人口結構趨向高齡化，代謝症候群與許多慢性疾病有年輕化的趨勢，更是助長了自費健檢的熱潮。因此，瞭解民眾對健康檢查之需求、使用經驗及使用意願，以及了解民眾選擇使用自費健康檢查的相關影響因素顯得尤為重要。 目的: 1.探討兩岸不同人口學特質的民眾在健康素養、健康信念、自費健檢使用經驗及使用意願之差異。2.探討不同人口學特質民眾之健康素養、健康信念對民眾使用自費健康檢查經驗之影響。3.探討不同人口學特質民眾之健康素養、健康信念對民眾使用自費健康檢查意願之影響。 方法:本研究採用立意取樣法，在 2017 年 2 月至 2017 年 4 月期間，透過結構式問卷对大臺北地區某三家健檢機構以及大陸深圳地區某三家健檢機構之有使用自費健檢的民眾來蒐集資料。兩岸各發放 300 份問卷，共計發放問卷 600 份。大台北地區有效回收問卷 229 份，有效回收率 76.33%；大陸深圳地區有效回收問卷 288 份，有效回收率96.00%。 研究結果:（一）兩岸的研究結果都發現，健康素養水平不同的民眾在自費健檢的使用經驗與使用意願上有著顯著差異。此外，健康素養較好的民眾比健康素養較不好的民眾有更豐富的使用經驗以及更強的使用意願。（二）不同人口學特質之民眾在自費健檢的使用經驗與使用意願上有著顯著差異。（三）有使用意願者之自覺罹病性、自覺嚴重性、行動利益及行動線索的分數比沒有使用意願者高，行動障礙分數則比沒有使用意願者低。（四）影響台灣民眾選擇使用自費健檢的主要因素有「健檢方案的多樣化」、健檢機構的「環境」以及是否有「時間」；影響深圳地區民眾的主要因素則是健檢機構的「服務」、「環境」以及後續的「健康管理」。（五）透過羅吉斯迴歸分析發現性別、婚姻狀況、個人經濟狀況、健康素養及行動線索等變項是影響大臺北地區受訪民眾是否願意選擇使用自費健康檢查的重要預測變項。（六）透過羅吉斯迴歸分析發現年齡、健康素養、自覺嚴重性、行動障礙及行動線索等變項是深圳地區受訪民眾是否願意選擇使用自費健康檢查的重要預測變項。

Background: Nowadays, the main factors that threaten people's health have changed from infectious diseases to lifestyle-related chronic diseases and physical degenerative diseases. The concept of three-stage disease prevention is highly applied in the prevention of both chronic disease and physical degenerative diseases, which aims to achieve early detection and treatment before onset of the disease. Accordingly, health examination is the most effective way to detect disease early. Meanwhile, The Preventive Health Care Services for Adults' has been established in Taiwan since 1996; however, its relatively simple content and age limitation can no longer meet the demands of the public. Therefore, many people would like to use self-paid health examination service. In recent years, the rise of self-paid health examination industry occurred in many other districts other than Taiwan. As the population structure of the mainland China tends to be aging, metabolic syndrome and many chronic diseases appeared earlier, people in mainland China tend to choose self-paid health examination as well. Therefore, it’s important to understand the public's demand for health examination, their experience and willingness to use, and the relevant factors that influence people’s choice of using self-paid health examination. Objectives: To examine the differences of people’s health literacy, health beliefs,self-paid health examination experience and willingness between Taipei and Shenzhen ; so as to explore the demographic characteristics impact on people’s health literacy, health beliefs, self-paid health examination experience and willingness. Method: Purposive sampling was used in this study, conducted in February to April, 2017, using structured questionnaire to survey the people who have used self-paid health examination in the health inspection agency in both Taipei and Shenzhen. 600 questionnaires was totally distributed, including 229 effective questionnaires from Taipei and 289 effective questionnaires from Shenzhen. Results: Health literacy and health beliefs were significantly associated with self-paid health examination experience and willingness. People with higher health literacy scores were significantly more likely to undergo self-paid health examinations. People with different demographic characteristics have different self-paid health examination experience and willingness. The influencing factors of Taipei public’s preference on choosing self-paid health examination mainly include:health examination package diversification, health examination centers’environment, and whether they have time for a health examination. Furthermore, the factors affecting Shenzhen public’s preference of choosing self-paid health examinations mainly include: the service of physicians and nursing staff/medical personnel (eg. professional skills and polite attitudes), the environment of health examination center, and health management. The results of logistic regression analysis showed that sex, marital status, economic status, health literacy, and cues to action were important predictive factors of willingness utilize self-paid health examination among Taipei respondents. Also, this study found that age, health literacy, perceived seriousness, perceived barriers, and cues to action could significantly predict the willingness utilize self-paid health examination among Shenzhen respondents.